Topics Related to Medicaid Managed Care

NC Medicaid to Change Coverage for GLP-1 Weight Management Medications

Effective Oct. 1, 2025, NC Medicaid coverage for GLP-1s for the treatment of obesity will be discontinued.

Rendering, Attending, Ordering or Referring Provider Information Required on Claims for NC Medicaid Managed Care

This bulletin applies to all NC Medicaid Managed Care providers.

Important Update on Tailored Plan & Prepaid Inpatient Health Plan Dually-Eligible Beneficiary Medicare Crossover Claims

NC Medicaid is now routing dual-eligible beneficiary Professional and Institutional Medicare Crossover claims to the designated NC Medicaid Managed Care payor.

NC Medicaid Temporary Flexibilities Due to Hurricane Erin

Flexibilities effective Aug. 19, 2025, for NC Medicaid beneficiaries due to Hurricane Erin

NC Medicaid to Cover Imported Benzathine Benzylpenicillin (Extencilline®) and Benzathine Benzylpenicillin Tetrahydrate (Lentocilin): Billing Guidelines

Effective with date of service Aug. 1, 2025, NC Medicaid covers benzathine benzylpenicillin (Extencilline®) and benzathine benzylpenicillin tetrahydrate (Lentocilin).

Nursing Facility Payment Changes Effective Sept. 1, 2025

NC Medicaid is implementing changes to the Nursing Facility process to support providers and members.

Updated 1915(i) Assessment

The revised NC Medicaid 1915(i) Assessment includes new date fields and must be used starting Oct. 1, 2025.

Announcing Coverage-67516 Suprachoroidal Space Injection of Pharmacologic Agent (separate procedure)

Current Procedural Terminology code 67516 has replaced category III code 0465T.

Updated: NC Medicaid Behavioral Health Intellectual/Developmental Disabilities Tailored Plans Federally Qualified Health Center/Rural Health Clinics Prospective Payment System - Alternate Payment Methodology wrap payment methodology

Reimbursement methodology changes revised to begin with dates of service on or after Dec. 1, 2024.

Updated: Federally Qualified Health Centers and Rural Health Clinics Reimbursement Methodology Changes Approved

Standard Plans will reimburse the APM rate for claims with a date of service on or after Aug. 1, 2024.